Management of MIH Lesions Using the HMI-TNI Index

Abstract

Introduction: Molar-Incisor Hypomineralization (MIH) is a qualitative defect in enamel development that primarily affects permanent molars and incisors. Due to its high prevalence, several classification systems have been proposed. Among them, the Würzburg concept and the HMI Treatment Need Index (HMI-TNI) stand out, offering various therapeutic options based on clinical manifestations and associated hypersensitivity. Objective: To determine the most appropriate diagnosis and treatment for patients with MIH using the HMI-TNI index as a guiding tool. Review: MIH is associated with genetic and epigenetic factors that interfere with proper enamel formation and mineralization. This results in porous, low-quality enamel that is more susceptible to caries, structural breakdown, early tooth loss, and hypersensitivity, all of which negatively impact the patient's quality of life. The HMI-TNI, developed in 2016, assesses factors such as the severity of the defect, dental sensitivity, caries risk, and the patient’s social environment. Based on these variables, it proposes individualized treatments focused on prevention, minimal intervention and esthetics. Conclusion: The severity of MIH lesions varies among patients; the MIH-TNI index may be a viable alternative that enables clinicians to make evidence-based decisions, tailoring treatment to the specific needs of each case. Recommendations: Comprehensive management of MIH requires collaboration between the clinician, the patient and their support system. Education regarding the condition and adherence to professional recommendations are key to achieving optimal outcomes. Continued clinical research is recommended to further validate the index's utility.